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Original article
Does internet-accessed STI (e-STI) testing increase testing uptake for chlamydia and other STIs among a young population who have never tested? Secondary analyses of data from a randomised controlled trial
  1. Emma Wilson1,
  2. Clémence Leyrat2,
  3. Paula Baraitser3,4,
  4. Caroline Free1
  1. 1 Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
  2. 2 Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
  3. 3 Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, UK
  4. 4 School of Population Health and Environmental Sciences, King's College London, London, UK
  1. Correspondence to Dr Emma Wilson, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; emma.wilson{at}


Objectives To assess the effectiveness of an internet-accessed STI (e-STI) testing and results service on testing uptake among young adults (16–30 years) who have never tested for STIs in London, England.

Methods We conducted secondary analyses on data from a randomised controlled trial. In the trial, participants were randomly allocated to receive a text message with the web link of an e-STI testing and results service (intervention group) or a text message with the link of a website listing the locations, contact details and websites of seven local sexual health clinics (control group). We analysed a subsample of 528 trial participants who reported never testing for STIs at baseline. Outcomes were self-reported STI testing at 6 weeks, verified by patient record checks, and time from randomisation to completion of an STI test.

Results Uptake of STI testing among ‘never testers’ almost doubled. At 6 weeks, 45.3% of the intervention completed at least one test (chlamydia, gonorrhoea, syphilis and HIV), compared with 24.1% of the control (relative risk [RR] 1.88, 95% CI 1.47 to 2.40, p<0.001). For chlamydia and gonorrhoea testing combined, uptake was 44.3% in the intervention versus 24.1% in controls (RR 1.84, 95% CI 1.44 to 2.36, p<0.001). The intervention reduced time to any STI test (restricted mean survival time: 29.0 days vs 36.3 days, p<0.001) at a time horizon of 42 days.

Conclusions e-STI testing increased uptake of STI testing and reduced time to test among a young population of ‘never testers’ recruited in community settings. Although encouraging, questions remain on how best to manage the additional demand generated by e-STI testing in a challenging funding environment. Larger studies are required to assess the effects later in the cascade of care, including STI diagnoses and cases treated.

  • testing
  • diagnosis
  • service delivery
  • programme evaluation

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  • PB and CF are joint senior authors.

  • Handling editor Sevgi O Aral

  • Contributors EW, PB and CF conceptualised the study. EW conducted the statistical analyses with guidance and supervision from CL. EW wrote the first draft of the manuscript. CL, PB and CF reviewed and commented on drafts of the manuscript. All authors approved the final version. PB secured funding for the project. PB and CF are both senior authors on this work. EW had full access to the data and had final responsibility for the decision to submit for publication.

  • Funding This study was funded by Guy's and St. Thomas' Charity, grant number: MAJ120505. PB secured the funding for this work.

  • Competing interests EW reports receiving a PhD studentship from Guy’s and St Thomas’ Charity via SH:24 (a not-for-profit community interest company). PB report grants from Guy’s and St Thomas’ charity via SH:24 (a not-for-profit community interest company) during the conduct of the study. CF reports receiving funding for her time from Guy’s and St Thomas’ Charity paid via SH:24 (a not-for-profit community interest company). PB is a director of SH:24 (a not-for-profit community interest company).

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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